Background
Methods
The PeDiAtrick project
Study design and setting
Characteristic | Buguruni | Vingunguti | Mbagala | Kizuiani | Sinza** | Tandale |
---|---|---|---|---|---|---|
Maximun no of HWs | 13 | 13 | 14 | 13 | 13 | 14 |
Number of smartphones | 4 | N/A | 5 | N/A | N/A | 3 |
Number of smartphones | 4 | N/A | 5 | N/A | N/A | 3 |
Number of tablets | N/A | 2 | N/A | 3 | 3 | N/A |
Maximum no of HWs in the morning shift at OPD | 4 | 2-3 | 4-5 | 4 | 5 | 3 |
Daily attendance of patients* | 200-250 | 120-150 | 400 | 150-200 | 500 | 300-500 |
Daily attendance of children <5 years* | 50-60 | 40-50 | 70-100 | 60 | 160 | 100-150 |
Participant selection and data collection
Data analysis
Ethical consideration
Results
Socio-demographic characteristics of the study participants
Health care worker perceptions related to the application of smartphones and tablets
Perceptions related to the application of smartphones and tablets
Feeling comfortable
“Of course I feel comfortable, not only because the tablet is a modern equipment, I know, I will not forget any symptoms related to disease. But sometimes […] you cannot remember everything, but by using ALMANACH you can tell this [child] has high respiration rate”. (IDI, male, tablet, very high uptake)
Rational judgement
“…the treatment provided by the tablet is short and clear, but there is also an opportunity to add other things […], it helps you to think more about the treatment”. (IDI, female, tablet, low uptake)
Patient’s trust
“Because as I have told you that from my experience, most of them want to be treated by using the ALMANACH, they believe that something that is electronically is much better, I think that is the belief of our patients”.(IDI, male, tablet, very high uptake)
Simplifying work
“… for example […] if the patient is coughing, for each cough we gave antibiotics but through the phone you know this is pneumonia or this is normal chest cough so there is no need of using antibiotics. But another thing is that, it simplifies work because you are instructed to give medicine according to the weight of the child, so you don’t need to do the calculation of a dose”. (IDI, male, smartphone, very low uptake)
Reduction of antibiotic prescription
“Yes, before I was prescribing antibiotics as antibiotics, I was just prescribing antibiotics, but truly now you don’t believe, now I know many diseases are febrile diseases, they don’t need antibiotics”. (IDI, female, smartphone, very high uptake)“… if you are using ALMANACH the antibiotic consumption is reduced, if you don’t use ALMANACH the consumption of antibiotics is high”. (IDI, female, tablet, very low uptake)
Correct classifications
“… so what was making me happy is that I used to get good diagnosis and good treatment” (IDI, female, smartphone, high uptake)“Because if you are following the phone, it guides you directly, so if you make a good follow-up, you will get accurate diagnosis”. (IDI, male, smartphone, low uptake)
Correct treatment
“There are many advantages; first, the phone is a reference point in the sense that if you have forgotten what the patient is suffering from, or treatment or medication, by following the instructions in the phone you will know the diagnosis and medicine to that diagnosis. So the phone helps a lot”. (IDI, male, smartphone, very low uptake)
Usability of devices
Typing
“This [typing] was difficult. This was a challenge for me. I was not familiar with the typing, it takes time to type.... I sometimes have to press and press, several times, it is difficult to use.” (IDI, female, smartphone, very low uptake).
Length of ALMANACH
“The biggest problem here is that we have few workers and a lot of patients, and if you see that you find it hard to ask a patient all those questions”. (IDI, female, smartphone, high uptake)
Health system barriers
Few health workers and many patients
“I feel free [to use the device] but the problem is the crowd of patients that we are supposed to attend, in our health facility we do not have enough staff, the use of phone is a barrier. The patients want to be treated and go back home early, so if they stay longer in the health facility, it becomes a problem”. (IDI, Male, smartphone, very low uptake)“… Now it is a challenge to us as I am alone, so sometimes I cannot use phone”. (IDI, Female, smartphone, very high uptake)“…if we had enough health workers, some for children and some for adults, then it could have helped a lot”. (FGD, female, smartphone)
Few laboratory staff
“You find that our laboratory has many patients, so the patient stays in the queue for long time, waiting for the results”. (IDI, female, tablet, very low uptake)
Lack of staff motivation
“They [the health workers] know there is no financial benefit, and they have conditioned themselves that phones waste time, knowing also that they do not get any income out of the phone use, that is the only reason when you come with this . . . not only the phone, when you come with books [IMCI chart booklets], and one is working with children since morning, you find that they don’t even read them, they do not have any interest. They take the phones the same way they deal with books. The only difference is that this is a phone and that is a book, which you need to open”. (IDI, female, smartphone, high uptake)
Increased paper work
“…yeah, it adds more work to us, because we have to enter the data in the phone, and then write the same data in the file, or patient’s card/notebook. In that way you do two things at the same time”. (IDI, male, smartphone, very low uptake)
Lack of drugs
“There is nothing which discourages you more as when you are using that tablet, and the caretaker has waited for such a long time, at the end you tell her, “go and buy the medicine outside or go to the medicine’s window” and there is no medicine, even the caretaker becomes discouraged, you have enrolled her in your tablet, and you have concentrated, at the end of the day, when she goes to the pharmacy she fails to get [the medicine]”. (IDI, female, tablet, very low uptake)“When caretakers see the phones, they also expect that drugs are available”. (FGD HW, male, smartphone)